Boomer in Chief
As the youngest and first Asian American president of AARP (formerly the American Association of Retired Persons), Jennie Chin Hansen, RN, MS, FAAN, embodies the changing face of this important advocacy organization and its 40 million members, one-third of whom are baby boomers.
Hansen, who is 59, was elected to her two-year term as AARP’s president in May 2008, bringing with her a wealth of expertise in health care and aging issues. According to her official AARP bio, she teaches nursing at San Francisco State University, holds an appointment as senior fellow at the University of California San Francisco’s Center for the Health Professions and is a past president of the American Society on Aging.
Hansen also spent nearly 25 years as executive director of On Lok, Inc., a not-for-profit family of organizations providing community-based health care and other social services for seniors in culturally diverse California communities. On Lok was the prototype for PACE (Program of All-Inclusive Care for the Elderly), which was signed into federal law in 1997, making this Medicare/Medicaid program available in all 50 states.
“I think I am probably the first nurse in this position [of AARP president] in 25 years,” Hansen says. “It is a tremendous honor and a tremendous responsibility.”
Hansen grew up in Boston, the daughter of parents who were immigrants from China. “Being very bicultural—my first language was Chinese—I bring [to AARP] a mindset that is able to [understand and work well] in a diverse, complex community,” she says. “There are many ways to look at life and living. I think [having a multicultural background] allows you that perspective, because you realize that you are always moving in multiple communities.”
In an extensive interview with Minority Nurse in early March, Hansen discussed several health care-related AARP initiatives and her goals for her presidency. Here are some highlights of that conversation.
Q: During the course of your nursing career, you went from community nursing to rural nursing to being a nurse advocate. How have these roles helped you in your current position at AARP?
I think one of the things you learn [in community nursing] is that when you are [working] outside of an institution, such as a hospital, people look at health and well-being a little differently. I think I am quite grounded in understanding the professional knowledge that we bring but also how people want and use information to maintain their well-being or to address their illness. That approach applies in rural health as well.
Growing up in a Chinatown community, I learned that you need to understand core values and help people view what is important in their lives. When you do that, it really informs how you help do community building or do advocacy. It is not something that is [done] top down. It is really about what matters to people at the living edge, as I call it. So you need to bring [everything] together in ways that make sense from a policy perspective, but it also has to make sense to people whose lives are directly affected by policy.
Q: What led you to AARP and your current position?
When I was president of the American Society on Aging, one of our board members was the [then] director of AARP’s Andrus Foundation, so we were colleagues. He was interested in recruiting members for [the foundation’s] board who would bring a different point of view that would help both the foundation and AARP itself begin to think more broadly.
I was actually brought in as an independent member of the board [in 2000] to add to the mix of what the core board offered. From that, I became part of the AARP affiliated family and was then invited to apply for a position on a larger AARP board.
Q: When you became AARP’s new president last year, you highlighted three core themes: the roles medications play in older people’s health; fall prevention; and encouraging important conversations about such issues as end-of-life preferences. Why those three themes?
It relates back to AARP’s current Divided We Fail joint initiative (www.DividedWeFail.org), which focuses on bringing the country together [to develop bipartisan solutions] for ensuring affordable, quality health care for all Americans, and also long-term economic security. This [initiative is a partnership between] the business community, the labor community and AARP, along with other independent organizations.
Since I am a nurse, I am focusing a little bit more on the health side, but [my approach also involves] showing how [health care] ties in to economic security, both for individual people and the country. We need to make these issues tangible and not political, bringing it down to specifics that regular people can do something about, regardless of [which political party is in power]. These are three themes that I think people can relate to.
People over 45 years old take, on average, at least four medications apiece. Medications are an important part of our daily lives. When we do not take them correctly, it costs money and it creates [health care] quality problems. The theme of medication is an important one to me. If people go into the hospital and then go home and do not take their medication correctly, they end up back in the hospital.
The second point was about falls. One in three people over the age of 65 will likely fall in a given year. This is the biggest cause of injury for older people. Half of the people [in this age bracket] who break a bone will die within the following year.
Half the falls that happen to older people happen in their own homes. This is an example of how we can use evidence-based practice [to create practical solutions]. The evidence from the Centers for Disease Control and Prevention tells us that there are simple things people can do to prevent falls from happening: make sure there are better light bulbs, that there are not slippery rugs in place, that electric wires are not crossing areas where people walk. They can also learn to do some exercises that strengthen trunk balance and prevent falls.
These are well-known strategies that involve little or no cost. So this is an area where we can use proven research and apply the [data] in our daily lives to enhance the quality and safety of living and save money.
The third theme is about how much money both individuals and the country spend on the last year of life for people. Oftentimes it doesn’t produce the quality or value that people really wanted. We spend more money on health care during the last six months of life than we do in our entire lifetime. Is that really the best use of our precious resources?
We need to focus more on having conversations [with loved ones about end-of-life care planning] because we all know how much angst occurs when a loved one goes into the hospital. Often family members have not had those conversations about the important changes that happen as we age. We need to bring our families together and have some of these conversations at a time that is not an emergency, because only in America do people think death is an option.
Q: How much support has there been for the Divided We Fail platform and how has it manifested itself?
Our core partners include the Business Roundtable, the National Federation of Independent Business and the Service Employees International Union. In addition to the big players, we have more than 100 independent groups that have joined in to pledge their support as well. On the legislative side, nearly 360 members of the last Congress have signed the pledge or written a letter of support on [the initiative’s] behalf.
[This year] we will host more than 50 events in nearly every state to educate the public about the contemporary issues of what is going on in health care reform and economic security. Part of this will be done through the globalization of town hall meetings, especially during this first Congressional recess, so that constituents and their lawmakers can really connect and discuss [these issues] directly. We will collectively present to the lawmakers the 1.6 million pledges that have been signed by people across the country, asking for this above-partisanship focus by our policymakers.
There are three particular policy areas we will focus on:
The first is access to health insurance coverage. We will try to build on the existing employer-based system while also thinking about other ways to provide coverage for people who are currently not insured. We all have a personal responsibility to make sure we have some good choices and participate in coming under the health care umbrella.
Second, we are looking at improving health care affordability, value and outcomes. Part of this includes a focus on preventive care programs, which again emphasizes the personal opportunity and responsibility people have.
Also, we need to address how poorly advanced our health care system is in the area of technology. We are focusing collectively on that to make sure the electronic highway system of communication will be built to help improve the quality of care and decrease health care costs.
We also need to make sure that the system rewards evidence-based care—in other words, not just [doing something] because somebody thinks it’s the best way, but [because it’s based on proven clinical evidence].
We need to make sure that care is coordinated. Older people who have multiple chronic diseases see anywhere from 10 to 14 doctors a year. We want to make sure that more effort is put into place to ensure that one doctor doesn’t inadvertently prescribe something that [will cause a negative interaction] because [they don’t know that] another doctor is treating that person with a different medication. Coordination of care is so important to make sure we are aligned together for good outcomes.
The third area is increasing quality and efficiency and making sure that we think about it from a patient-centered standpoint, so that the patient is not shunted around from place to place and the delivery of care is smoother and well-coordinated on behalf of that individual
[We also need to] compare the effectiveness of different treatments. Sometimes medication may be more effective than surgery. This kind of research really needs to be done and promoted and used. Divided We Fail [calls for] increasing comparative effectiveness in all parts of the health care system and making sure that the public [can access and understand] this information.
We do know there is a lot of money in the health care system—over $700 billion every year, according to the Congressional Budget Office—that is not being used well. Beyond the need for new money, there is money in the system already that can be better used on behalf of coverage and on behalf of quality.
Q: Another joint initiative AARP is involved in, along with the AARP Foundation and the Robert Wood Johnson Foundation, is the Center to Champion Nursing in America (www.championnursing.org), which is addressing the nursing shortage as well as the shortage of nursing faculty. Last month the Center, in collaboration with the Health Resources and Services Administration (HRSA) Division of Nursing and the Department of Labor (DOL), convened a national Nursing Education Capacity Summit, which brought together teams from nearly all 50 states to discuss solutions to the nursing shortage. What came out of that summit?
What we are doing is aligning all the efforts [across the country, including sharing] of some of the best practices that have been implemented in some of the states. We have states that have signed up to [share information] at the ground level about what some of the best practices are and facilitate the forming of coalitions to bring that about [on a national level].
We are bringing together [representatives from DOL and business], because [they are stakeholders too; we have to] make sure we have a nursing workforce. And we are also bringing in other foundations [that are concerned with aging issues] to try to make sure that not only are we [increasing the number of] nurses in general but also addressing a particular need for nurses to know about [the health care needs of older people] and the complexity of those needs, such as having multiple chronic diseases. This follows on the heels of the  Institute of Medicine report Retooling for an Aging America: Building the Health Care Workforce.
This initiative is also helping to support [health care-related provisions in] the
current economic stimulus bill to make sure that not only is the government
funding nursing education but also education for all [the many] health professionals that are going to be needed for elder care in the future.
So the summit helped bring all of these efforts together to say that this is a national problem and we need advocacy, practice and new ways to think about the care of older people in America.
Q: What are the goals of the Center to Champion Nursing in America?
One of its objectives is to help support the infrastructure for increasing the number of nursing faculty. Without more faculty, thousands of people get turned away [from nursing schools, because there are not enough nursing educators to teach them].
The second goal is the whole aspect of retaining nurses. This especially speaks to people who are middle-aged nurses. Are there ways in which we can help in retention of existing, practicing nurses?
Number three is the ability to advance nurses further into leadership roles, so that they can help represent our profession throughout larger organizations and foundations [that can help shape health policymaking]. We are the largest health care workforce in America. There are nearly 3 million nurses in America right now [compared to] about 750,000 physicians. The contribution and voice [of nurses] to help shape where health care is going to be in the future is an important part of having nurse leaders embedded in the country.
Q: Even though there are 3 million nurses, people of color are very underrepresented in the RN workforce. In your personal opinion as a minority nurse, what can be done to attract more minorities into nursing?
I think having nurses of color as faculty [is important], but there also has to be a focus on providing [more] educational opportunities for [future minority] nurses, such as [bridge programs] that align community college programs with baccalaureate programs. Many students who are immigrants or people of color might find it easier to start with a community-college level of access, so we need to ensure that there is an open pipeline that can lead them to more advanced nursing credentialing, such as bachelor’s and master’s degrees. Some people may find that starting with a BSN program is prohibitive economically. So it may well be that [putting more emphasis on] community colleges as a beginning venue, especially in large urban areas, might be one opportunity to increase the pool of [minority] nurses.
Given [America’s] diversity and the known health care disparities, it is so important to have a workforce that reflects the population.
Q: President Obama’s Health Summit is happening this week. The president is proposing a $634 billion down payment on health care reform. What are your thoughts about what is happening at that summit right now?
One great thing is that all the input and constructive thinking is open and on the table, so we know we agree to these core principles and that there are many ways to approach this. The openness to different ideas that may be delivered is extremely promising. We are recognizing that the need for health care reform is a problem for the whole country, not for one party or another, not for one sector or another. I think if we are able to hold that [inclusive, non-partisan] tone, some give and take will occur. The bottom line is that we have to protect the country’s economic security, and that is so tied to health care security. We have to spend the money, invest in it, but spend it well.
The fact that insurance companies and businesses, as well as advocacy groups [are all coming together and] saying we are committed to change is a very different space to be in than we had back in 1993-94, which was the last attempt at health care reform.
Q: Is there anything else you’d like to add?
This is such an important opportunity for minority nurses and students to become active in thinking not only about the clinical care we give and the research that is in our field, but about the economics, politics and policy issues. It is a time when we need to raise our own bar in understanding both how we fit into the picture and how we can lead the country.